减重手术强化康复方案的实施。来自法语国家的大型数据库研究结果。

Implementation of enhanced recovery programs for bariatric surgery. Results from the Francophone large-scale database.

机构信息

Department of Digestive Surgery, University Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France.

出版信息

Surg Obes Relat Dis. 2018 Jan;14(1):99-105. doi: 10.1016/j.soard.2017.09.535. Epub 2017 Oct 4.

DOI:10.1016/j.soard.2017.09.535

PMID:29122527

Abstract

BACKGROUND

The feasibility, safety, and efficacy of programs for enhanced recovery after bariatric surgery (ERABS) are now well established. However, data concerning their large-scale implementation remain insufficient.

OBJECTIVES

The objective of the present study was to review the multicenter implementation of ERABS SETTING: This retrospective analysis of a prospective database was conducted in 15 Groupe francophone de Rehabilitation Améliorée après ChirurgiE centers from data from March 2014 to January 2017.

METHODS

The Francophone working Group for Enhanced Recovery After Surgery (Groupe francophone de Rehabilitation Améliorée après ChirurgiE) edited and released protocols of ERABS for its members. Compliance with ERABS, lengths of hospital stay, and postoperative morbidity were obtained from the Groupe francophone de Rehabilitation Améliorée après ChirurgiE-audit database.

RESULTS

In this study, 1667 patients were included. Procedures were sleeve gastrectomy (n = 1011), gastric bypass (n = 300), or mini-bypass (n = 356). Mean body mass index was 41.8 ± 8.3 kg/m. Global morbidity was 2.57%, and surgery-related morbidity was 1.67% (mostly anastomotic leakages and hemorrhage). Mean length of hospital stay was 2.4 ± 3.6 days. Overall compliance was 79.6%. Among the 23 elements of the ERABS program, 14 were applied in>70% of instances, 6 in between 50% and 70%, and 3 in<50%. The elements least often applied were limb intermittent pneumatic compression during surgery (23.3%), multimodal analgesia (49.5%), and optimal perioperative fluid management (43.8%).

CONCLUSION

This study shows that even if the overall compliance was good, the large-scale implementation of ERABS can still be improved, as several elements remain insufficiently applied. This finding highlights the importance of thorough, continuous training in addition to the need for repeated audits by centers involved in ERABS programs.

摘要

背景

减重手术后加速康复方案（ERABS）的可行性、安全性和疗效现已得到充分证实。然而，有关其大规模实施的数据仍不充分。

目的

本研究旨在回顾 ERABS 的多中心实施情况。

设置

这是对 2014 年 3 月至 2017 年 1 月期间来自 15 个法国康复增强外科组（Groupe francophone de Rehabilitation Améliorée après ChirurgiE）的数据的前瞻性数据库进行的回顾性分析。

方法

法国外科增强康复工作组（Groupe francophone de Rehabilitation Améliorée après ChirurgiE）为其成员编辑并发布了 ERABS 方案。从 Groupe francophone de Rehabilitation Améliorée après ChirurgiE-审核数据库中获得 ERABS 依从性、住院时间和术后发病率。

结果

本研究共纳入 1667 例患者。手术方式为袖状胃切除术（n = 1011）、胃旁路术（n = 300）或迷你旁路术（n = 356）。平均体重指数为 41.8 ± 8.3kg/m2。总体发病率为 2.57%，与手术相关的发病率为 1.67%（主要为吻合口漏和出血）。平均住院时间为 2.4 ± 3.6 天。整体依从率为 79.6%。在 ERABS 方案的 23 个要素中，有 14 个要素的应用率>70%，6 个要素的应用率在 50%至 70%之间，3 个要素的应用率<50%。应用率最低的要素是手术时肢体间歇性气动压缩（23.3%）、多模式镇痛（49.5%）和优化围手术期液体管理（43.8%）。